Training and Certification in Imaging for Endoscopic Surgeons

Diagnosis and preoperative staging of endometriosis have a crucial role in planning surgical procedure in a multidisciplinary setting. Ultrasound and magnetic resonance imaging (MRI) are the imaging modalities of choice for deep pelvic endometriosis evaluation and are slowly replacing diagnostic laparoscopy across specialist centers in Europe and recently in the UK. This is however a high-level specialist procedure that is not routinely available and hence is not generally widely available. In order to gain competence in scanning, one should follow recommendations in the training curricula, as defined by professional bodies such as the Royal College of Obstetricians and Gynaecologists (RCOG), European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) or International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG). Endoscopic surgeons should be aware of training requirements in imaging when assembling an endometriosis center team. At the time of writing, few surgeons in the UK perform an expert-level scan themselves, or offer joint imaging-gynecology appointments, let alone have enhanced understanding of the role of preoperative findings. Despite the widespread use of ultrasound in tertiary endometriosis centers worldwide and the importance of setting standards in imaging practice, the UK has lagged behind in setting standards for integrated imaging practice in accredited endometriosis centers. Defining specialist ultrasound skills required to practice in gynecological endoscopy will determine the formalized training pathway. In this chapter, we aim to present a cogent argument for robust ultrasound training and certifications for professionals working in endometriosis centers, which may one day be included in the accreditation requirements for endometriosis centers.